| NPI | 1124654942 |
|---|---|
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 171000000X Military Health Care Provider (Licence: TN 65330) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: MS 32213) |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2023-12-09 |